Clinician looking at x-ray

What is the study about?

The adapted Marshall computed tomography (CT) classification scheme is used to classify the severity of TBI using the results from a CT scan. The aim of this study was to first examine the predictive relationship between an adapted Marshall classification scheme and other clinical measures of injury severity (e.g. duration of post-traumatic amnesia, neurosurgical procedures) and then determine if the Marshall classification scheme contributes to the prediction of clinical, disposition, functional, and participation outcomes at rehabilitation discharge and at 1 year after injury.

What did the study find?

The outcome measures at rehabilitation discharge were length of stay in days, Functional Independence Measure (FIM) total score, FIM motor score, FIM cognitive score, and the Disability Rating Scale (DRS) score. Outcome measures at one-year post injury were FIM total score, FIM cognitive score, DRS score, and the Extended Glasgow Outcome Scale. This study looked at the contribution that the Marshall classification scheme made in predicting eight outcomes. These outcomes included: 1) intracranial hypertension during acute hospitalization; 2) craniotomy or craniectomy during acute hospitalization; 3) interruption in care during inpatient rehabilitation; 4) rehabilitation discharge to a private residence; 5) rehospitalization during the year after rehabilitation discharge; 6) living in a private residence at 1 year; 7) productive activity at 1 year, and 8) death during the year after rehabilitation discharge. The adapted Marshall classification scheme only helped in the prediction of need for skull surgery (craniotomy or craniectomy) during acute hospitalization. It did not meaningfully predict acute clinical indicators of injury severity nor predict functional or participation outcomes at rehabilitation discharge or 1 year after TBI.

Who participated in the study?

This study included 4895 individuals who received inpatient rehabilitation following acute hospitalization for TBI and were enrolled in the Traumatic Brain Injury Model Systems National Database between 1989 and 2014.

How was the study conducted?

Prediction models were used to determine the degree of varience in outcomes explained by the CT classification categories when compared to the more commonly used predictors.

How can people use the results?

These findings can be used by clinicians, individuals with TBI and their families to help them understand the limitations of using head CT findings in the acute phase of injury to predict disposition and functional outcomes at rehabilitation discharge and one year after TBI.


Brown, A. W., Pretz, C. R., Bell, K. R., Hammond, F. M., Arciniegas, D. B., Bodien, Y. G., . . . Zafonte, R. (2019). Predictive utility of an adapted Marshall head CT classification scheme after traumatic brain injury. Brain Injury, 33(5), 610-617. doi:10.1080/02699052.2019.1566970

The contents of this quick review were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90DP0082). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this quick review do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the Federal Government.